State of Texas HIV Planning &

Goals for the National HIV/AIDS Strategy 1.Reduce new HIV infections 2.Increase access to care and improve health outcomes for people living with HIV 3.Reduce HIV-related health disparities

1. Reduce new HIV infections Lower the annual number of new infections by 25% Reduce HIV transmission by 30% Increase the percentage of people living with HIV who know their sero-status from 79% to 90% 2. Increase access to care and improve health outcomes for people living with HIV Increase the proportion of newly diagnosed patients linked to clinical care from 65% to 85% Increase the proportion of Ryan White HIV/AIDS Program clients who are in continuous care from 73% to 80% Increase the number of Ryan White clients with permanent housing from 82% to 86% 3. Reduce HIV-related health disparities Improve access to prevention and care services for all Americans Increase the proportion of HIV-diagnosed gay and bisexual men with undetectable viral load by 20% Increase the proportion of HIV-diagnosed Blacks with undetectable viral load by 20% Increase the proportion of HIV-diagnosed Latinos with undetectable viral load by 20%

Gardner Cascade Continuum

Texas HIV Population Treatment Cascade, 2012

Fort Worth Abilene Wichita Falls

Texas HIV Plan Update for DEPARTMENT OF STATE HEALTH SERVICES HIV/STD Prevention and Care Branch, Shelley Lucas, Manager

Texas HIV Spectrum of HIV Engagement

2014 – 2015 Texas Priorities The 27 priorities were developed from several meetings / consultations over the last couple of years. Discussions were had about the priorities in planners’ network meetings, with Part A administrators, with internal DSHS staff and with community members. The current list has been revised based on feedback from the first release of the Texas HIV Plan and on review of the Part A plans from across the state. We then looked at the Part A plans goals/objectives and implementation strategies. We reviewed all of the Part A plans and mapped the goals/objectives to the state plan. In order to make the document readable we had to take the various goals from each plan and generalize them into broader statements.

Domain I: Increasing HIV awareness among members of the general public, community leaders, and policy makers ○ Assure availability of key information for consumers, providers and policy makers Re-energize HIV awareness efforts through implementation of a media plan specifying priority stakeholders and messages. Who: DSHS, NCT, Houston; Timeline: Plans completed by March 31, Plans implemented April – December ○ Draw attention to the role of social determinants in the spread of HIV Incorporate a focus on social determinants to community mobilization and HIV care systems. Who: DSHS and local leaders of mobilization efforts and NCT providers; Timeline: Actions taken in 2013 and 2014.

Domain I: Increasing HIV awareness among members of the general public, community leaders, and policy makers o Form broad community alliances of traditional and non- traditional stakeholders to support the HIV mission Facilitate delivery of technical assistance and training for local health departments, community based providers, FQHCs and Medicaid providers to prepare for health care system changes and to increase the capacity of non-traditional providers to serve HIV infected persons. Who: DSHS, NCT and Houston; Timeline: Actions taken in 2013 and 2014.

Domain II: Increasing access to HIV prevention efforts for high risk groups ○ Focus prevention programs on those most at risk as determined by epidemiology ○ Address the environment and system issues that intensify HIV in vulnerable populations Actively train providers and partners in the role of social determinants of health. Who: DSHS, NCT; Timeline: Ongoing in 2013 and ○ Increase knowledge and sense of urgency to act in high risk populations Develop targeted media strategies focused on vulnerable population to increase HIV awareness and testing. Who: DSHS, Houston, NCT; Timeline: Plans completed by December 31, Expand Greater than AIDS or other Act Against AIDS campaigns to cover 5 major urban areas. Who: DSHS, NCT, Houston, Dallas, San Antonio, Austin; Timeline: at least one focused campaign mounted in each area by December 31, 2014.

Domain III: Full diagnosis of all HIV infections ○ Evaluate effectiveness of HIV testing programs at the population and program level ○ Effectively identify and test individuals in populations at highest risk ○ Ensure that social and sexual networks of HIV infected persons are offered testing and counseling Expand the number of partners and members of social and sexual networks of HIV-infected persons who receive partner services (e.g. identification, notification, counseling and testing, linkage to care for partners and members of social and sexual networks) Who: DSHS, Houston, NCT; Timeline: Ongoing through 2013 and 2014.

Domain III: Full diagnosis of all HIV infections o Expand adoption of routine HIV testing as a part of medical care ○ Address stigma that prevents providers from offering testing and people form seeking or accepting testing ○ Adopt testing technologies that simplify testing, increase access or acceptability, or increase early diagnosis ○ Build social norms in high risk populations to seek health care

Domain IV: Speedy and timely linkage to HIV related care and treatment ○ Assure linkage systems that are client centered and responsive to circumstances and needs ○ Create approaches to locate and link HIV infected individuals who know their status but are not in care Establish a uniform definition for “lost to care” clients to allow more standardized assessment of the scope of the issue, inform standards of care, and facilitate evaluation of efforts to return persons to HIV care. Who: Houston, Austin, NCT, DSHS Timeline: March31, Develop protocols for using surveillance data to identify persons out of care, and local activities to locate and return them to care. Who: Houston, Austin, NCT, DSHS; Timeline: Protocols developed by September 30, 2013; protocols implemented and evaluated by September 30, ○ Use technology that supports linkage to care ○ Address stigma and other issues that prevent HIV infected individuals from seeking medical care

Domain V: Continuous participation in systems of care and treatment ○ Increase focus and training on retention in care Identify and provide training and support for best practices in retention in care. Who: NCT, DSHS, Houston; Ongoing in 2013 and ○ Ensure that care systems include access to supportive services Continue support for supportive services prioritized in community service delivery plans. Who: Austin, Dallas, DSHS, NCT, Houston, San Antonio; Timeline: ongoing through 2013 and Expand transportation services, both urban and rural, through collaboration and alternative funding. Who: San Antonio and NCT; Timeline: Ongoing in 2014.

Domain V: Continuous participation in systems of care and treatment o Ensure that care systems include access to behavioral health services Continue to provide funding for services to supplement locally available behavioral health services. Who: Austin, Dallas, DSHS, NCT, Houston, San Antonio; Timeline: ongoing in 2013 and Increase involvement and cross training with SAMHSA- funded HIV Early Intervention case managers. Who: NCT and DSHS; Timeline: ongoing in Increase training and technical assistance to enhance ability of HIV case managers serve clients with behavioral health needs. Who: NCT, Houston, DSHS; Timeline: ongoing in ○ Create mechanisms to identify and respond to individuals at risk of dropping out of care ○ Address stigma issues and social norms that prevent HIV infected individuals from maintaining their HIV care Increase client’s self-sufficiency though education and development of focused care plans. Who: NCT, Houston.

Domain VI: Increased viral suppression ○ Increase understanding of viral suppression as a key health indicator ○ Expand access to HIV clinical care Expand the use of telemedicine to build access primary care, behavior health services, and specialists. Who: San Antonio, NCT, DSHS; Timeline: Ongoing in Enhance access to treatment and care through integration of preventive and treatment services, collaboration between traditional and non-traditional providers of treatment and care, co-location of HIV treatment, supportive, and specialty services to effectively treat co-morbid conditions, and increased involvement of FQHC in HIV testing and care delivery. Who: Dallas, San Antonio, NCT, Houston; Timeline: Ongoing in 2013 and ○ Enhance access to medication and treatment for co-occurring and co-morbid conditions

Domain VI: Increased viral suppression o Create a focus on adherence that includes clients, clinicians and supportive services providers Distribute information to providers on best practices in promoting adherence and to clients on the importance of treatment adherence through partnerships with AETC and PTC, local provider networks, and coalitions of consumers associated with Ryan White Planning Councils. Who: DSHS, Houston, NCT; Timeline: throughout Maintain or start programs to enhance health literacy and to enhance client understanding of treatment Who: DSHS, Houston, NCT, San Antonio; Timeline: throughout ○ Address the stigma that prevents individuals infected with HIV from adhering to treatment

Texas HIV Plan Developing and Establishing Priorities November 13-14, 2013

Red = NCT original prioritiesBlack Bold = first round state priorities

Domain I: Increasing HIV awareness among members of the general public, community leaders, and policy makers oAoAssure availability of key information for consumers, providers and policy makers ○ Draw attention to the role of social determinants in the spread of HIV ○ Form broad community alliances of traditional and non-traditional stakeholders to support the HIV mission Domain II: Increasing access to HIV prevention efforts for high risk groups ○ Focus prevention programs on those most at risk as determined by epidemiology ○ Address the environment and system issues that intensify HIV in vulnerable populations ○ Increase knowledge and sense of urgency to act in high risk populations Domain III: Full diagnosis of all HIV infections ○ Evaluate effectiveness of HIV testing programs at the population and program level ○ Effectively identify and test individuals in populations at highest risk ○ Ensure that social and sexual networks of HIV infected persons are offered testing and counseling ○ Expand adoption of routine HIV testing as a part of medical care ○ Address stigma that prevents providers from offering testing and people form seeking or accepting testing ○ Adopt testing technologies that simplify testing, increase access or acceptability, or increase early diagnosis ○ Build social norms in high risk populations to seek health care Domain IV: Speedy and timely linkage to HIV related care and treatment ○ Assure linkage systems that are client centered and responsive to circumstances and needs ○ Create approaches to locate and link HIV infected individuals who know their status but are not in care ○ Use technology that supports linkage to care ○ Address stigma and other issues that prevent HIV infected individuals from seeking medical care Domain V: Continuous participation in systems of care and treatment ○ Increase focus and training on retention in care ○ Ensure that care systems include access to supportive services ○ Ensure that care systems include access to behavioral health services ○ Create mechanisms to identify and respond to individuals at risk of dropping out of care ○ Address stigma issues and social norms that prevent HIV infected individuals from maintaining their HIV care Domain VI: Increased viral suppression ○ Increase understanding of viral suppression as a key health indicator ○ Expand access to HIV clinical care ○ Enhance access to medication and treatment for co-occurring and co-morbid conditions ○ Create a focus on adherence that includes clients, clinicians and supportive services providers ○ Address the stigma that prevents individuals infected with HIV from adhering to treatment

Where to go with all this 2014 Comprehensive Plan? Service Priorities? Additional Assessments? Monitoring?